Resuscitation Guidelines update. Dr. Luis García-Castrillo Riesgo EuSEM Vice president

Transcription

1 Resuscitation Guidelines update Dr. Luis García-Castrillo Riesgo EuSEM Vice president

2 There are no COIs to disclose in this presentation.

3 CPR Mile Stones William Kouwenhoven, cardiac massage International Symposium on Emergency Resuscitation, Oslo, Norway. AHA Standards and guidelines CPR and ECC 1974, 1980, 1986, 1992.

4 1992 CPR Guidelines First International Meeting Sodium Bicarbonate in CPR. Early Public Access Defibrillation. Chain of survival. ILCOR foundation.

5 2000 CPR Guidelines The world s first international to produce International Resuscitation Guidelines. Simplification of Adult BLS Ratio 100x 15:2. Treatment of cardiac arrest with a "shockable" rhythm, deliver up to three "stacked" shocks without CPR between the shocks. Comparable Effectiveness: Bag-Mask Device May Be as Effective as Tracheal Tube. Death Pronouncement in the Field, the Futility of Transport of Patients Needing Continued CPR

6 2005 CPR Guidelines International Consensus on Cardiopulmonary Resuscitation(CPR) and Emergency Cardiovascular Care(ECC) with Treatment Recommendations (CoSTR). The ratio of compressions-to-ventilations has been changed to 30:2. Rescuers now deliver 1 shock (360J monophasic) followed by CPR, not 3 shocks. Lay rescuers no longer check for circulation. Other algorithms have been simplified.

7 2010 CPR Guidelines International Consensus on Cardiopulmonary Resuscitation(CPR) and Emergency Cardiovascular Care(ECC) with Treatment Recommendations (CoSTR). An adjustment to the CPR process from A B C (Airway Breathing Compressions) to C A B. An increased emphasis on High Quality CPR. Revoking previous recommendations for performing cricoid pressure.

8 2015 Guidelines Goals Reduce inventory of science with much more frequent focused updates. Adopt an internationally recognized, transparent system for evaluating scientific evidence. Encourage broad participation in the process. Enhance quality of scientific reviews. Speed development of revised guidelines.

9 ILCOR Taskforces for Advanced Life Support 2. Basic Life Support 3. Paediatric Life Support 4. Neonatal Life Support 5. Acute Coronary Syndromes 6. Education, Implementation & Teams 7. First Aid (new for 2015) 8. (Methodology Group)

10 2015 Guidelines: Methodology ILCOR, Scientific Evidence Evaluation and Review System (SEERS) 1. Questions PICO PICO stands for Patient/population, Intervention, Comparison and Outcome (Picos) In community dwelling adults, how effective is hands-only CPR, versus hands plus breathing CPR, at preventing mortality? 2. Evaluation of the evidence: Grading of Recommendations Applicability, Development and Evaluation (GRADE)

11 2015 Guidelines: Methodology GRADE Quality of evidence High Moderate Low Very low Strength of recommendation We recommend using We suggest using We recommend against using We suggest against using Guatt GH. BMJ 2008;336:924-6

12 Guidelines Implementation Guidelines must take into account: Science Education issues Cost effectiveness Cultural differences

13 2015 CPR Guidelines New Guidelines Questions High-Quality CPR. A sweet spot for the rate of chest compressions of may be established. Supporting research has shown a slower compression rate may restrict the heart muscles from perfusion, while a faster compression rate puts providers at risk of performing less effective compressions, and/or making mistakes during the CPR process.

14 Cardiac Arrest Compression rate The AHA Guidelines for CPR Compression to ventilation rate rescuers: 15:2 2 rescuers: 5:1 Rate of compression Initial breaths 60/min 4 staircase Same as /min 4 staircase Same as /min 2 full breaths 12 Ventilation rate 1992 Same as /min 2 full breaths & 2 rescuers: 15:2 100/min 2 breaths & 2 rescuers: 30:2 100/min 2 breaths 8-10 advanced airway & 2 rescuers: 30:2 At least 100 C-A-B 8-10 breaths/min

15 Cardiac Arrest Compression rate 2010 Guidelines Chest compressions at least 100/min. About half of responders are giving chest compressions too fast, with about a third above 120 compressions per minute, and 20 percent above 140 per minute. Idris : Data from the Resuscitation Outcomes Consortium. Prehospital Resuscitation. Pool of patients. First 5 min CPR. Increase in rate decrease in deepness. ROSC Chest compressions Survival to hospital discharge ROSC >140-4% -5% % 9% Control Control % <80-1% JEMS Sep; 37(9): 4 9. Crit Care Med. 2015

16 Compression rate 2015 Guidelines Treatment Recommendation: We suggest a manual chest compression rate of 100 to 120 compressions per minute for adults in cardiac arrest in any setting (weak recommendation, very low quality of evidence).

17 Cardiac Arrest Hypothermia 2010 Guidelines In summary, we recommend that comatose adult patients with ROSC after out-ofhospital VF cardiac arrest should be cooled to 32 C to 34 C for 12 to 24 hours. (Class I, LOE B). When How How long At what level..

18 Cardiac Arrest Hypothermia Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest Cardiac Arrest Trial, two branches (Shockabel rhythms) 32-34º (137)(24 h) Normothermia (138) N Engl J Med 2002; 346:

19 Cardiac Arrest Hypothermia Niklas Nielsen Cardiac Arrest Trial two branches (GCS <8) 33º (24 h) 36º N Engl J Med 2013; 369:

20 Cardiac Arrest Hypothermia Francis Kim: Effect of Prehospital Induction of Mild Hypothermia on Survival and Neurological Status Among Adults With Cardiac Arrest. Cardiac Arrest Trial, Four branches, Out of Hospital cooling. 1. Ventricular Fibrillation. 1. Cold Fluids 2. Standard 2. Non Ventricular Fibrillation. 1. Cold Fluids 2. Standard Prehospital cooling reduces temperature to <34ª one hour before. JAMA. 2014;311(1):45-52

21 Hypothermia 2015 Guidelines Treatment Recommendation: We recommend selecting and maintaining a constant, target temperature between 32 C and 36 C for those patients in whom temperature control is used (strong recommendation, moderate-quality evidence). Whether certain subpopulations of cardiac arrest patients may benefit from lower (32-34oC) or higher (36oC) temperatures remains unknown, and further research may help elucidate this. tions-for-the-2015-aha-guidelines

22 Algorithms structure Resuscitation algorithms-linear or Circular? Perkins GD, Handley AJ, Raffay V, Monsieurs KG, Castren M. Resuscitation 2015.

23 Algorithms structure

24 Algorithms structure

25 CPR Outcomes Have the latest CPR guidelines improved cardiac arrest outcomes Denmark JAMA. 2013;310(13):

26 2015 Guidelines To be Publish Oct Circulation and Resuscitation on October 15, Thanks for your attention